Relation of Coronary Artery Calcium and Extra-Coronary Aortic Calcium to Incident Hypertension (from the Multi-Ethnic Study of Atherosclerosis)

Amer I. Aladin, Mahmoud Al Rifai, Shereen H. Rasool, Zeina Dardari, Joseph Yeboah, Khurram Nasir, Matthew J. Budoff, Bruce M. Psaty, Roger S Blumenthal, Michael Blaha, John W. McEvoy

Research output: Contribution to journalArticle

Abstract

Arterial calcification reflects an atherosclerotic process associated with vascular stiffness. Whether baseline coronary artery calcium (CAC) and extra-coronary calcium (ECC), measured using noncontrast computed tomography imaging, are associated with incident hypertension is poorly understood. We studied participants from the Multi-Ethnic Study of Atherosclerosis without measured or self-reported hypertension at baseline. Incident hypertension was defined by blood pressure criteria (BP, ≥140/90 mmHg), BP medication use, or both, and was assessed at in-person visits. We analyzed incident hypertension using multivariable-adjusted discrete-time proportional hazards models. Net reclassification improvement (NRI) assessed whether CAC reclassified hypertension risk when added to the Framingham hypertension risk score. Among 3,304 subjects analyzed, mean age was 59 ± 10 years; 48% were male and 42% were white. There were 1,283 incident hypertension cases over a median (interquartile range) follow-up time of 10.6 (4.5, 11.5) years. Each 1-unit increase in ln(CAC+1) was independently associated with a 12% higher risk of hypertension (95% confidence interval [CI] 9% to 16%). Relative to CAC = 0, patients with CAC >400 had a hazard ratio for incident hypertension of 2.2 (95% CI 1.8 to 2.9). There was no interaction by age, gender, or baseline BP (p = 0.43, 0.19, 0.09, respectively). Continuous NRI analyses demonstrated that CAC can reclassify risk of incident hypertension; NRI = 0.19 (95% CI 0.10 to 0.26). Furthermore, all measurements of ECC were significantly associated with incident hypertension, even after adjustment for CAC (hazard ratios ranging from 1.36 to 1.38). In conclusion, patients with CAC and ECC are at markedly higher risk of incident hypertension and may benefit from more intensified prevention efforts.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2017

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Atherosclerosis
Coronary Vessels
Hypertension
Calcium
Confidence Intervals
Vascular Stiffness
Proportional Hazards Models
Tomography
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of Coronary Artery Calcium and Extra-Coronary Aortic Calcium to Incident Hypertension (from the Multi-Ethnic Study of Atherosclerosis). / Aladin, Amer I.; Al Rifai, Mahmoud; Rasool, Shereen H.; Dardari, Zeina; Yeboah, Joseph; Nasir, Khurram; Budoff, Matthew J.; Psaty, Bruce M.; Blumenthal, Roger S; Blaha, Michael; McEvoy, John W.

In: American Journal of Cardiology, 01.01.2017.

Research output: Contribution to journalArticle

Aladin, Amer I. ; Al Rifai, Mahmoud ; Rasool, Shereen H. ; Dardari, Zeina ; Yeboah, Joseph ; Nasir, Khurram ; Budoff, Matthew J. ; Psaty, Bruce M. ; Blumenthal, Roger S ; Blaha, Michael ; McEvoy, John W. / Relation of Coronary Artery Calcium and Extra-Coronary Aortic Calcium to Incident Hypertension (from the Multi-Ethnic Study of Atherosclerosis). In: American Journal of Cardiology. 2017.
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abstract = "Arterial calcification reflects an atherosclerotic process associated with vascular stiffness. Whether baseline coronary artery calcium (CAC) and extra-coronary calcium (ECC), measured using noncontrast computed tomography imaging, are associated with incident hypertension is poorly understood. We studied participants from the Multi-Ethnic Study of Atherosclerosis without measured or self-reported hypertension at baseline. Incident hypertension was defined by blood pressure criteria (BP, ≥140/90 mmHg), BP medication use, or both, and was assessed at in-person visits. We analyzed incident hypertension using multivariable-adjusted discrete-time proportional hazards models. Net reclassification improvement (NRI) assessed whether CAC reclassified hypertension risk when added to the Framingham hypertension risk score. Among 3,304 subjects analyzed, mean age was 59 ± 10 years; 48{\%} were male and 42{\%} were white. There were 1,283 incident hypertension cases over a median (interquartile range) follow-up time of 10.6 (4.5, 11.5) years. Each 1-unit increase in ln(CAC+1) was independently associated with a 12{\%} higher risk of hypertension (95{\%} confidence interval [CI] 9{\%} to 16{\%}). Relative to CAC = 0, patients with CAC >400 had a hazard ratio for incident hypertension of 2.2 (95{\%} CI 1.8 to 2.9). There was no interaction by age, gender, or baseline BP (p = 0.43, 0.19, 0.09, respectively). Continuous NRI analyses demonstrated that CAC can reclassify risk of incident hypertension; NRI = 0.19 (95{\%} CI 0.10 to 0.26). Furthermore, all measurements of ECC were significantly associated with incident hypertension, even after adjustment for CAC (hazard ratios ranging from 1.36 to 1.38). In conclusion, patients with CAC and ECC are at markedly higher risk of incident hypertension and may benefit from more intensified prevention efforts.",
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AU - Aladin, Amer I.

AU - Al Rifai, Mahmoud

AU - Rasool, Shereen H.

AU - Dardari, Zeina

AU - Yeboah, Joseph

AU - Nasir, Khurram

AU - Budoff, Matthew J.

AU - Psaty, Bruce M.

AU - Blumenthal, Roger S

AU - Blaha, Michael

AU - McEvoy, John W.

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